Public values failure occurs when the market and the public sector fail to provide goods and services required to achieve the core values of society such as equity (Bozeman 2007). That public policy for emerging health technologies should address intrinsic societal values such as equity is not a novel concept. However, the ways that the public values discourse of stakeholders is structured is less clear and rarely studied through the lens of public interests. This is especially true in the health (...) sciences discourse. Using the public value mapping (PVM) model I present a case study of the intrinsic value of equity in nanomedicine for cancer and the imperatives for translational research, an instrumental value to achieve equity. After reviewing and coding nearly 700 value statements from several hundred public documents, I find that that the discourse on values varies between documents that address basic research and documents that address the application of the knowledge produced in basic research, with some especially notable disconnections. This paper demonstrates the importance of further refinement of methods for testing the PVM framework if the societal goal is to improve consistency of the public value discussion by those involved in developing and applying new technologies. The paper also demonstrates the value of a PVM approach for complex science policy analysis, especially for emerging technologies like nanomedicine. (shrink)

This paper details a “metadisciplinary” applied ethics course jointly taught and pioneered by a biologist, psychologist, and ethicist on the subject of Assisted Reproduction. Contrasted with a transdisciplinary approach (whose content involves themes or issues that span traditional disciplinary lines) and a multidisciplinary approach (which involves experts from several disciplines working side by side), a metadisciplinary approach involves both of these former characteristics while incorporating a continuous, critical appreciation for the strengths and weaknesses of the contrasting methods and scopes of (...) each discipline’s methods of inquiry. This paper details the kinds of subjects that lend themselves to metadisciplinary approaches (e.g. applied ethics subjects which are real-world, complex, and studied by various disciplines), staffing guidelines for a smoothly functioning core team, how to plan and prepare the day-to-day of such a course to prevent a diffuse lesson structure, assignment and evaluation guidelines, and an appraisal of the value of such a class. The authors argue that while fundamental research may be conducted along traditional disciplinary lines, solutions to the complex problems of contemporary society require people who are equipped with problem-solving skills whose relevance spans disciplinary boundaries. (shrink)

A dearth of literature focuses on the relationship between acculturation, power distance and liminality for migrant nurses entering foreign workplaces. Expectations are for migrant nurses to be practice‐ready swiftly. However, this aspiration is naïve given the complex shifts that occur in deeply held cultural beliefs and practices and is dependent on an organisational climate of reciprocal willingness to adapt and learn. This exploratory study identified that although a plethora of literature addresses challenges migrant nurses face, there are limited data that (...) link these transitional processes to concepts that might usefully guide transitions. This study draws from the overarching concept of acculturation, together with Hofstede's (2011) notion of power distance and the theory of liminality to explore the experiences of eight migrant nurses. Data highlighted that adjusting to altered hierarchical relationships took many months because negotiating power distance challenged deeply held beliefs and assumptions about professional and organisational hierarchies. Migrant nurses’ accounts indicated a paucity of organisational processes to address these difficulties; therefore, they navigated this liminal space of adjustment to power distance differences in an ad hoc manner. Their acculturation experiences, arguably unnecessarily prolonged, indicate the value in workplace commitment to exploring a collaborative, critically reflective approach to optimise transitions. (shrink)

Mammalian sperm undergo discharge of a single, anterior secretory granule following their attachment to the zona pellucida surrounding the oocyte. This secretory discharge is known for historical reasons as the acrosome reaction. It fulfils a number of purposes and without it, sperm are unable to penetrate the zona pellucida and fuse with the oocyte. In this review, we focus on the role of the acrosome reaction in the development of fusion competence in sperm. Any naturally occurring membrane fusion has two (...) major sequential steps: a docking or adhesion step, in which two membranes adhere, and a fusion step, in which their lipid bilayers are destabilized and merged and a cellular compartment is either created or destroyed. Recent evidence suggests that there is an important role for oocyte integrins and sperm‐bound disintegrins in mammalian sperm/oocyte adhesion and fusion. The fusion mechanism employed by sperm remains poorly understood, however, and circumstantial evidence suggests it is more complex than the interaction between a single protein species and its target. Sperm/oocyte fusion is probably the most accessible eukaryotic model for intercellular fusion currently available, partly because it is temporally separated from gene expression. Elucidation of the mechanism of sperm/oocyte fusion may throw light on the mechanism of other intercellular fusions such as myoblast fusion, and the evolutionary relationship of intercellular membrane fusion to intracellular membrane fusion. (shrink)

Is Leo Strauss truly an intellectual forebear of neoconservatism and a powerful force in shaping Bush administration foreign policy? _The Truth about Leo Strauss_ puts this question to rest, revealing for the first time how the popular media came to perpetuate an oversimplified view of a complex and wide-ranging philosopher. In doing so, it corrects our perception of Strauss, providing the best general introduction available to the political thought of this misunderstood figure. Catherine and Michael Zuckert—both former students of (...) Strauss—guide readers here to a nuanced understanding of how Strauss’s political thought fits into his broader philosophy. Challenging the ideas that Strauss was an inflexible conservative who followed in the footsteps of Nietzsche, Heidegger, and Carl Schmitt, the Zuckerts contend that Strauss’s signature idea was the need for a return to the ancients. Through their work, they conclude that Strauss was a sober defender of liberal democracy, aware of both its strengths and its weaknesses. Balanced and accessible, _The Truth about Leo Strauss_ is a must-read for anyone who wants to more fully comprehend this enigmatic philosopher and his much-disputed legacy. “_The Truth about Leo Strauss_ is the most balanced and insightful book yet written about Strauss’s thought, students, and political influence. It dispels myths promulgated by both friends and foes and persuasively traces the conflicting paths that American thinkers indebted to Strauss have taken.”—William Galston, Brookings Institution. (shrink)

Is Leo Strauss truly an intellectual forebear of neoconservatism and a powerful force in shaping Bush administration foreign policy? _The Truth about Leo Strauss_ puts this question to rest, revealing for the first time how the popular media came to perpetuate such an oversimplified view of such a complex and wide-ranging philosopher. More important, it corrects our perception of Strauss, providing the best general introduction available to the political thought of this misunderstood figure. Catherine and Michael Zuckert—both former students (...) of Strauss—guide readers here to a nuanced understanding of how Strauss’s political thought fits into his broader philosophy. Challenging the ideas that Strauss was an inflexible conservative who followed in the footsteps of Nietzsche, Heidegger, and Carl Schmitt, the Zuckerts contend that Strauss’s signature idea was the need for a return to the ancients. This idea, they show, stemmed from Strauss’s belief that modern thought, with its relativism and nihilism, undermines healthy politics and even the possibility of real philosophy. Identifying this view as one of Strauss’s three core propositions—America is modern, modernity is bad, and America is good—they conclude that Strauss was a sober defender of liberal democracy, aware of both its strengths and its weaknesses. The Zuckerts finish, appropriately, by examining the varied work of Strauss’s numerous students and followers, revealing the origins—rooted in the tensions within his own thought—oftheir split into opposing camps. Balanced and accessible, _The Truth about Leo Strauss_ is a must-read for anyone who wants to more fully comprehend this enigmatic philosopher and his much-disputed legacy. (shrink)

Moral emotions shape the effectiveness of culturally diverse teams. However, these emotions, which are integral to determining ethically responsive patient care and team relationships, typically go unrecognised. The contribution of emotions to moral deliberation is subjugated within the technorational environment of healthcare decision‐making. Contemporary healthcare organisations rely on a multicultural workforce charged with the ethical care of vulnerable people. Limited extant literature examines the role of moral emotions in ethical decision‐making among culturally diverse healthcare teams. Moral emotions are evident in (...) ethnocentric moral perspectives that construct some colleagues' practices as ‘other’. This article examines how moral emotions are evoked when cultural dissonance influences nurses' moral perceptions. We use a qualitative investigation of teamwork within culturally diverse healthcare organisations. We use Haidt's () account of moral emotions to examine practice‐based accounts of 36 internationally educated and 17 New Zealand educated nurses practising in New Zealand. The study provides evidence that moral emotions are frequently elicited by communication and care practices considered ‘foreign’. The main implication is that although safe practice in healthcare organisations is reliant on highly functioning teams, collaboration is challenged by interprofessional power relations of contested culturally shaped values. We address practice‐based strategies that enable engagement with moral emotions to enhance effective teamwork. (shrink)

Background To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. Methods The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were (...) conducted with 75 staff, residents and family members. Results It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation. Conclusion While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life. No data are available. (shrink)

BackgroundThe existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values...

Sexually transmitted infections (STIs) are socially constructed as more ‘dirty’ than other gynaecological conditions. This article analyses women’s accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a ‘moral event,’ different from other consultations. This moral component is highlighted drawing on Foucault’s notion of ‘the confessional.’ Additionally, Douglas’ anthropological construction of ‘dirt’ is used to consider why these consultations are ‘confessional’ experiences. Email interviews were conducted with 26 (...) women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral ‘work’ in clinical consultations about a viral STI diagnosis: the particular ‘dirtiness’ of viral STIs, clinicians as moral agents, the ‘non‐judgmental’ clinician, women juggling truth‐telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non‐judgmental. (shrink)

This study articulates the relational constituents of good care beyond techno‐rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical‐surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed (...) iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity. (shrink)

This study articulates the relationship between conceptualisations of time and the accounts of good care in an acute setting. Neoliberal healthcare services, with their focus on efficiencies, predominantly calculate quality care based on time‐on‐the‐clock workforce management planning systems. However, the ways staff conceptualise and then relate to diverse meanings of time have implications for good care and for staff morale. This phenomenological study was undertaken in acute medical–surgical wards, investigating the contextual, temporal nature of care embedded in human relations. The (...) study interviews involved 17 participants: 11 staff, 3 previous patients and 3 family members. Data were analysed iteratively to surface the phenomenality of temporality and good care. The following constituents of the data set are explored that together illustrate the relationship between the conceptualisations of time and the accounts of good care in an acute setting: patient time as a relational journey; patient time, sovereign time and time ethics and time, teamwork and flow. The findings are clinically significant because they offer a contrasting narrative about the relationship between time and care quality. The experiences of giving and receiving good care are indivisible from how temporality is experienced and the social relations within which care is embedded. Healthcare staff experience temporality differently from patients and families, a point that healthcare participants in this study appeared to comprehend and accommodate. For all parties involved in providing care or being the recipient of care, however, the capacity to be present was valued as a humanising ethic of care. Our study reinforces the importance of not creating presumptive binaries about which temporal structures are more or less humanising—there is a place for a fast‐paced tempo, which can be experienced as being in the flow of human relations with one's team and on behalf of patients. (shrink)

Unlike some other reproductions of classic texts (1) We have not used OCR(Optical Character Recognition), as this leads to bad quality books with introduced typos. (2) In books where there are images such as portraits, maps, sketches etc We have endeavoured to keep the quality of these images, so they represent accurately the original artefact. Although occasionally there may be certain imperfections with these old texts, we feel they deserve to be made available for future generations to enjoy.

Leo Strauss and his alleged political influence regarding the Iraq War have in recent years been the subject of significant media attention, including stories in the _Wall Street Journal _and _New York Times._ _Time_ magazine even called him “one of the most influential men in American politics.” With _The Truth about Leo Strauss_, Michael and Catherine Zuckert challenged the many claims and speculations about this notoriously complex thinker. Now, with _Leo Strauss and the Problem of Political Philosophy_, they turn (...) their attention to a searching and more comprehensive interpretation of Strauss’s thought as a whole, using the many manifestations of the “problem of political philosophy” as their touchstone. For Strauss, political philosophy presented a “problem” to which there have been a variety of solutions proposed over the course of Western history. Strauss’s work, they show, revolved around recovering—and restoring—political philosophy to its original Socratic form. Since positivism and historicism represented two intellectual currents that undermined the possibility of a Socratic political philosophy, the first part of the book is devoted to Strauss’s critique of these two positions. Then, the authors explore Strauss’s interpretation of the history of philosophy and both ancient and modern canonical political philosophers, including Plato, Aristotle, Machiavelli, and Locke. Strauss’s often-unconventional readings of these philosophers, they argue, pointed to solutions to the problem of political philosophy. Finally, the authors examine Strauss’s thought in the context of the twentieth century, when his chief interlocutors were Schmitt, Husserl, Heidegger, and Nietzsche. The most penetrating and capacious treatment of the political philosophy of this complex and often misunderstood thinker, from his early years to his last works, _Leo Strauss and the Problem of Political Philosophy_ reveals Strauss’s writings as an attempt to show that the distinctive characteristics of ancient and modern thought derive from different modes of solving the problem of political philosophy and reveal why he considered the ancient solution both philosophically and politically superior. (shrink)